Philosophical transactions, Vol. L. Part I. For the year 1757. / Giving some account of the present undertakings, studies, and labours, of the ingenious, in many considerable parts of the world.

by Various; Royal Society

II.

Some Observations on the Case of the late Right Honourable Lord Walpole, of Woolterton: In a Letter to Dr. John Pringle, F.R.S. By Robert Whytt, M.D. F.R.S.

Edinburgh, March 16. 1757.

SIR,

Read April 21, 1757.

PHysicians have not, perhaps, differed more widely in any thing, than in their opinions of the medicines lately proposed for the cure of the stone. While some imagined, that Mrs. Stephens's medicines, or soap and lime-water, were in most cases to accomplish a dissolution of the stone; others have been positive, that nothing of this kind was to be expected from them: nay, they have condemned these medicines, when used in large quantities, and long persisted in, as hurtful to the stomach, guts, and urinary passages; and have ascribed the remarkable ease, which they almost always give to calculous patients, to their depositing a calcarious powder upon the surface of the stone, by which it is rendered less hurtful to the bladder. And this opinion seems to have been not a little strengthened, by the great quantity of white sediment observed in the urine of those patients, who have used soap and lime-water in considerable quantities. Now, as I am of opinion, that most of these objections and doubts, concerning the effects of soap and lime-water in the cure of the stone, may be cleared by a candid consideration of Lord Walpole's case, I shall trouble you with a few remarks, which have occurred to me, in comparing it with the appearances found in his Lordship's body after death, of which you were so obliging as to send me a particular account.

1. Whatever doubts may have been entertained concerning the cause of Lord Walpole's complaints, yet it now appears evidently beyond dispute, that they must have been owing, not to a scorbutic corrosive humour in his bladder, as was imagined by some[125], but to stones lodged in it. These stones may possibly have lain there since 1734; for from that time to spring 1747, his Lordship was free of any gravelish complaints, only passing some red sand at times. But at what time soever they may have first arrived in the bladder, in 1747 and 1748 they seem to have acquired such a bulk, or were become so rough or pointed in their surface, as to occasion great pain, frequent provocations to urine, and sometimes bloody urine; especially after any considerable motion. These complaints, however, were soon relieved, by swallowing daily an ounce of Alicant soap, and three English pints of lime-water made with calcined oyster-shells; and from 1748 to 1757 his Lordship was kept almost intirely free from any return of them, except for some months of 1750 and 1751, during which he took only one-third part of the quantity of soap and lime-water above-mentioned[126].

2. It is highly probable, nay, I think, altogether certain, that the soap and lime-water not only relieved Lord Walpole of the painful symptoms occasioned by the stones in his bladder, but also prevented their increase.

If these stones came into the bladder in 1734, they must, in so many years as his Lordship lived after this, have acquired a very great bulk: nay, if we suppose them not to have been lodged in the bladder above a year before they began to occasion frequent inclination to make urine, with pain, and sometimes sudden stoppages of urine; yet, from 1746 to 1757, they ought to have grown to a much larger size than that of the kernel of a Spanish nut[127]. 'Tis true, the stone may increase faster in some patients, and slower in others; but stones, after remaining a dozen or more years in the bladder, generally weigh several ounces. Some years since l saw a stone, weighing near six ounces, taken from a boy of no more than 14 years of age.

3. Lord Walpole's case not only shews the power of soap and lime-water to relieve the painful symptoms, and prevent the increase, of the stone in the bladder, but also makes it probable, that these medicines do communicate to the urine a power of dissolving the stone.

In the beginning of 1749 his Lordship voided with his urine a calculous substance of a flat shape, about the bigness of a silver penny, and covered with a soft white mucus[128]; and upon the surfaces of the stones found in his bladder there were some inequalities, which seemed to have been made by the separation of thin lamellæ or scales. Further, the small stone found in the beginning of the urethra must have been in a dissolving state, and considerably lessened in the bulk: for, if it had lain long in the bladder, and never been larger, it ought to have been voided thro' the urethra with the urine; and it could not have arrived lately in the bladder, since Lord Walpole had not had, for several years before his death, any nephritic pains, or symptoms of stones passing from the kidnies; and since it is not likely, that a stone of the size and shape of the seed of an apple[129] would pass thro' the ureters without being felt. Now if this small stone, found in the urethra, was partly dissolved by the virtue of the soap and lime-water; it will appear at least probable, that the two larger stones in the bladder were so likewise. But altho' Lord Watpole's calculous concretions had remained undiminished, and without any symptoms of dissolution; it would not therefore follow, that soap and lime-water cannot dissolve the stone in other patients, where the concretion may be of a less firm texture.

The Rev^d. Dr. Richard Newcome, now Lord Bishop of Llandaff, while drinking two English quarts of lime-water daily, for the cure of the stone in his bladder, poured his urine every morning and evening upon a piece of human calculus weighing 31 grains; by which, in the space of four months, it was reduced to three pieces, weighing in all only six grains. Upon one of these pieces, weighing 2.31 grains, he caused to be daily poured, for two months, the fresh urine of a person, who drank no lime-water; at the end of which time the piece of calculus was found to weigh 2.56 grains, having increased in weight a quarter of a grain. This same piece being afterwards steeped in the bishop's urine (who continued to drink lime-water as above), from June 24th to July 9th, was in these few days quite crumbled into powder. Since this experiment shews, beyond dispute, that lime-water, unassisted by soap, can communicate to the urine a power of dissolving the stone out of the body, it can scarcely be doubted, that it must have the like effect on it, when lodged in the bladder. And that the dissolution of the stone in the bladder has been completed by soap alone, appeared evidently in the case of the Rev. Mr. Matthew Simson, Minister of Pancaitland near Edinburgh; an account of which will soon be made public[130] by Dr. Austin, who opened his body after death. Mr. Simson had, from 1730, been afflicted in a less or greater degree with the symptoms of a stone in the bladder; and in November 1735 was sounded by Dr. Drummond of Perth, and Mr. Balderston, surgeon in this city, by whom a stone was not only plainly felt, but also by the patient himself. In February 1737 he began to take soap; and after 1743 never had any gravelish symptoms. He died in May 1756; and, when his bladder was looked into, there was neither stone nor gravel found in it.

4. It appears from Lord Walpole's case, that soap and lime-water, even when taken in large quantities, proceed very slowly in dissolving the stone.

From July 1748, to the beginning of 1757, his Lordship drank three English pints of lime-water, and swallow'd for the most part an ounce of soap, daily; except from April 1750 to June 1751, during which time he took only one pint of lime-water, and one-third part of an ounce of soap, daily. However speedily soap and lime-water may dissolve the greatest part of urinary stones out of the body, yet being mixed with the aliment and humours of the stomach and guts, and afterwards with the whole mass of blood, it is impossible but their force must be greatly impaired before they arrive with the urine at the bladder. When, therefore, urinary stones are of an uncommon hard texture, we are perhaps scarcely to expect any sensible dissolution of them by the use of soap and lime-water: but when they are of a softer kind, there is no reason to doubt, that these medicines will in time dissolve them; and this will happen sooner or later, in proportion to the hardness of the stone, to the quantity of the medicines swallowed by the patient, and the exact regimen he observes, as to diet[131].

But however slowly soap and lime-water may proceed in dissolving the stone, yet they generally give speedy relief to the patient. Lord Walpole did not take these medicines in the full quantity till the end of July 1748; and, in a few months after, he was not only greatly relieved of all his complaints, but in December was able to ride an hundred miles in his coach, without finding any uneasiness, altho' the two last days of the journey the horses went at a full trot[132]. In winter 1750, and spring 1751, when his Lordship swallowed only one third part of the soap and lime-water, which he had been in use to take, his pains and frequent inclination to make urine returned in a good degree[133]; but, after taking the medicines in the full quantity, he soon became as easy as before[134].

It would seem, while Lord Walpole used only one pint of lime-water and one third of an ounce of soap daily, that the petrifying quality of his urine was not intirely destroyed, and that the stony particles newly formed on the surface of the calculi occasioned, by their roughness, the return of his painful symptoms. However, when he had recourse to the medicines in a larger quantity, the petrescent quality of his urine was not only destroyed, but this fluid seems to have acquired a power of dissolving the rough stony particles deposited on the surface of the calculi; and in this way soon removed the pain, bloody urine, and frequent desire to make water, upon using any considerable exercise.

Soap and lime-water not only relieve the painful symptoms occasioned by the stone, by wearing off its sharp points, and rougher parts, which used to irritate the tender membrane, which lines the bladder; but, when this membrane has been wounded or lacerated by the stone, there is nothing, that will heal it more speedily than lime-water; which the ingenious Dr. Langrish has found to be remarkable also for its effects in curing the bladders of dogs, after being fretted with soap-lees[135].

The power of soap and lime-water to alleviate the painful symptoms attending the stone is so great, that, as far as I remember, I have only met with one patient, who did not find himself considerably relieved by them. But it is to be observed, that this patient neither took them in full quantity, nor persisted in their use for a long enough time: and, when he was afterwards cut, the stone taken out of his bladder was almost as thick set with sharp prickles, as the back of an hedgehog: so that, in this case, no remarkable ease could be procured to the patient by the medicines, until they had quite dissolved these sharp points, and rendered the surface of the stone smooth and equal; which was not to be done but after a very long time, especially as the stone was of a pretty hard texture.

It may be proper to take notice, that when, along with the stone, there is any ulceration in the bladder, soap does mischief, and lime-water often fails of giving any considerable relief. However, even in this case it is perhaps one of the best remedies we know.

5. Soap and lime-water, taken in large quantities, and persisted in for many years together, appear to be innocent, and no way injurious to health.

Lord Walpole, who used these medicines for upwards of eight years, was not only relieved of the painful symptoms of the stone, but had his health improved by them in other respects[136]. His appetite, healthful look, and a degree of spirits uncommon at his age, continued till the end of 1756, when his last illness begin to attack him. And as his health did not appear to be any way injured by these medicines, so, where his body was opened after death, his kidneys and ureters were observed to be quite sound and natural, as was likewise his bladder; only its coats appeared a little thicker than usual, owing probably to the long-continued friction of the stones upon it. Neither the kidneys, ureters, nor bladder, were loaded or crusted with any calcarious matter; an effect most unjustly ascribed to soap and lime-water, since in the urinary passages, to which the air has no access, they cannot deposite their calcarious part[137]; and since the white stuff observable in the urine of such patients, as take these medicines in large quantities, is only the usual sediment of the urine changed in its nature and colour, with, perhaps, some of the dissolved particles of the stone[138].

As the urinary passages were no-way injured, so neither were the stomach, guts, and other viscera of the lower belly. These had all a healthful appearance, except the gall-bladder, which was almost full of biliary concretions: nor is it surprising, that soap and lime-water, which prevent the growth of urinary calculi, should have no effect on biliary stones, since, altho' these medicines dissolve the former out of the body, yet they do not make the smallest impression on the latter.

I presume it will be needless to take notice, that the lingering nervous fever, of which Lord Walpole died, cannot, with any colour of reason, be ascribed to the large use of soap and lime-water; since, if they could have produced such an effect, they must have done it in much less time than eight years and an half.

It may not be amiss to observe, that altho' soap and lime-water, taken in large quantities, are no-way injurious to health, yet in some cases they may become improper, on account of the particular state of the patient. Thus, in a scorbutic or putrid disposition of the humours, soap at least ought to be totally omitted; and such patients, who are much troubled with the hæmorrhoids, ought to be sparing in its use, as the alkaline salt, with which it abounds, will scarcely fail to exasperate their pain. Where the patient is naturally very costive, less lime-water and more soap ought to be used; and, on the contrary, where the body is too loose, little or no soap is to be taken, but the cure is to be trusted to lime-water alone; which, in this case, ought to be drank to the quantity of two English quarts a day.

As the foregoing observations will, I am afraid, appear more tedious than important, I shall only add, that I am, with great esteem,

SIR,
Your most obedient humble Servant,
Robert Whytt.